An atypical presentation and management of late-onset uveitis-glaucoma-hyphema (ugh) syndrome: a case report of single-piece intraocular lens

We present the diagnostic and management challenges of a rare case of late-onset Uveitis-Glaucoma-Hyphema (UGH) syndrome following uneventful cataract surgery.A 70-year-old female patient presented to our clinic with complaints of blurred vision.Intraocular pressure (IOP) was 48 mm Hg in the left eye.To control the refractory IOP, Ahmed glaucoma valve tube implantation was performed.Postoperatively, IOP decreased to 18 mm Hg.Two months later, the patient continued to report blurred vision.Slit-lamp biomicroscopy revealed a clear cornea, a +++ cell reaction in the anterior chamber with pigments, and a well-centered posterior chamber intraocular lens (PCIOL).Dilated fundus examination showed recurrent vitreous haze/hemorrhage.A pars plana vitrectomy (PPV) was planned to address the vitreous hemorrhage and evaluate the IOL position, which was incompletely assessed due to the mid-dilated pupil.During the procedure, a spatula was inserted under the middilated pupil to reveal adhesions between the iris and the IOL haptic and it was found that one haptic of the IOL was in the sulcus.The IOL and capsular bag complex was explanted.The new IOL was implanted using the flattened haptic end technique.The surgery concluded with PPV to remove the vitreous hemorrhage.Six months later, corrected visual acuity was 20/25 and IOP was 18 mm Hg.This case demonstrates that even a well-centered IOL can, in rare instances, lead to UGH and that a definitive diagnosis may only be established during surgical exploration.Therefore, adopting a multidisciplinary approach is crucial in addressing late-onset UGH syndrome.